Sander Wint 2002.

Study characteristics
Methods	RCT. 2 arms.
Participants	Number of children: 13 control, 17 treatment Sex of children: 16 M, 14 F Age range of children: 10 ‐ 19 years Mean age of children: not reported (median = 13.6 years) Needle procedure: LP Diagnosis: acute lymphoblastic leukemia (ALL), or lymphoma Inclusion criteria: 10 ‐ 19 years old, being treated for cancer, receiving LPs as part of therapy and undergoing at least a second LP, able to understand and communicate in English, able to hear and see Exclusion criteria: none reported Setting: clinic treatment room at pediatric teaching hospital in the South West, USA
Interventions	1.Virtual reality distraction: In addition to standard care, adolescents wore virtual reality glasses that provided 3D viewing and music in stereo sound. Nurses explained the purpose of the virtual reality glasses and the need for adolescents to focus their attention on what they were hearing and seeing. 2. Standard care control: Adolescents received standard nursing care including conscious sedation, topical anesthetic, explanation of the procedure, and parental presence.
Outcomes	Pain measure: Child self‐report: 100 mm VAS Adverse events: none mentioned
Notes	Study dates: study dates not reported Funding: Oncology Nursing Foundation Novice Researcher and Mentorship Grant Conflicts of interest: none declared
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Randomized ‐ no further details. Insufficient information to permit judgment of 'low' or 'high' risk
Allocation concealment (selection bias)	Unclear risk	Insufficient information to permit judgment of 'low' or 'high' risk
Blinding of participants and personnel (performance bias) All outcomes	High risk	Study participants and personnel were not blinded
Blinding of outcome assessment (detection bias) All outcomes	High risk	No blinding of self‐report outcome assessment
Incomplete outcome data (attrition bias) All outcomes	Low risk	No missing data
Selective reporting (reporting bias)	High risk	One or more outcomes of interest are reported incompletely
Other bias	High risk	Multiple potential sources of bias related to study design and other problems (e.g., small and unequal sample size)